Provider Demographics
NPI:1972312809
Name:PAIN EXPERTS OF ARIZONA PC
Entity type:Organization
Organization Name:PAIN EXPERTS OF ARIZONA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHDEV
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPPUSAMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-550-9393
Mailing Address - Street 1:PO BOX 29650
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9650
Mailing Address - Country:US
Mailing Address - Phone:480-550-9393
Mailing Address - Fax:
Practice Address - Street 1:10213 N 92ND ST STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4561
Practice Address - Country:US
Practice Address - Phone:480-550-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAIN EXPERTS OF ARIZONA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty